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Music EducationInternational Journal of
http://ijm.sagepub.com/content/25/3/259Theonline version of this article can be found at:
DOI: 10.1177/0255761407087263
2007 25: 259International Journal of Music EducationAdena Portowitz and Pnina S. Klein
with learning difficultiesMISC-MUSIC: a music program to enhance cognitive processing among children
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MISC-MUSIC: a music program to enhancecognitive processing among childrenwith learning difficulties
ADENA PORTOWITZYehuda Amir Institute for Social Integration in the Schools, Bar-Ilan University, IsraelPNINA S. KLEINBar-Ilan University, Israel
Abstract
Research findings confirm positive links between music education, scholastic achievement,and social adaptability, especially among at-risk and special needs children. However, fewstudies explain how this process occurs. This article presents a didactic approach, whichsuggests practical ways of enhancing general learning skills while teaching music.Conducted with young children with severe learning difficulties aged 410, the MISC-MUSIC (More Intelligent and Sensitive, or Socially Compliant Children) program (Klein, 1996)interconnects the following three components: (1) the content of the music lessons; (2)
the creation of educational frameworks that nurture quality, active teacherchild inter-actions (mediated learning environments), and (3) the choice of relevant, general learn-ing skills (cognitive functions) to be fostered during the music lesson. The article explains thetheoretic premises of MISC-MUSIC, cites examples of how this approach was implemented,and reflects on the effectiveness of the program.
Key wordscognitive modifiability, mediation, MISC, music education
Introduction
One of the important long-term objectives of education is to help individuals adapt to
the changing conditions of life. Difficult for all children, and especially for young children
with special needs, this process requires a high degree of mental flexibility, facilitated by
well-developed thinking strategies. Educational programs designed to address such goals
emphasize meta-cognitive training within conventional learning contexts (such as math
and science). The current article joins with such educational programs and suggests that
children may also improve important thinking strategies through the process of studying
music. It opens with an overview of research findings that specify positive links between
music education and academic and social achievement. It then enumerates select learn-
ing skills that were targeted during the MISC-MUSIC (More Intelligent and Sensitive, or
Socially Compliant Children) program, and concludes with preliminary findings.
INTERNATIONAL JOURNAL OF MUSIC EDUCATION Copyright 2007 International Society for Music Education
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260 INTERNATIONAL JOURNAL OF MUSIC EDUCATION 25(3)
The literature
Research has repeatedly confirmed that arts education contributes to academic achieve-
ment, motivation, and social skills, especially among students from underprivileged back-
grounds and children with special needs (Bamberger, 2000b; Bresler, 2002; Catterall, 2002;
Hodges & OConnell, 2005; Scripp, 2002; Winner & Hetland, 2000; Wolff, 1978). Thus,
for example, positive correlations have been found between the study of music and the
development of spatial-temporal reasoning (Hetland, 2000; Rauscher, 1999; Rauscher and
Zupan, 2000; Rauscher et al., 1997), achievement in math (Bamberger & DiSessa, 2003;
Graziano, Peterson, & Shaw, 1999; Vaughn, 2000), and achievement in reading (Atterbury,
1985; Nicholson, 1972). Within the domain of social well-being, music has been found
to contribute positively to school attendance (Hood, 1973), self-efficacy (Kennedy, 1998),
social activities (Aldridge, Gustorff, & Neugebauer, 1995; Frick, 2000), and self-regulation
(McPherson & Zimmerman, 2002).
Many explanations have been offered as to why music promotes learning. Children
with learning difficulties are often deterred from trying to cope with scholastic challenges.
Music is an alternative field where children can succeed, even if their verbal and mathe-
matical skills are comparatively weak. It has also been suggested that the innate joy
derived from music can motivate these children to participate in musical activities; their
active participation can then be used to promote learning.
More specifically, however, researchers have identified general cognitive skills that seem
to develop while studying music. Thus, for example, Ruggeri (2003) found that the con-
scious experience of enjoying music is often accompanied by a less conscious learning
process that involves perceptual, emotional, intuitive, and kinesthetic growth. While these
findings relate to adult education, it appears that they apply to children as well (Portowitz,
2004).
The current study the MISC-MUSIC program
Whereas in the above-mentioned studies associations were found between music educa-
tion and achievement after the training, the current study is unique in that it is specifi-
cally designed to promote thinking processes through the study of music.
MISC-MUSIC is part of an extended program sponsored by the Baker Center for
Research and Treatment of Children with Special Needs at Bar-Ilan University, Israel. Atthe Center, children with special needs study with trained teachers who help them acquire
skills in areas related to language, reading, writing, and music.1 Based on a series of
observations conducted over two academic years (October 2005June 2006)), this study
documented work with eight children, ranging in age between 4 and 10 years, who par-
ticipated in the MISC-MUSIC program. Six of the children had Down syndrome and two
had other severe learning difficulties. All the children received a weekly music lesson of
one hour, attended by the child and a parent. The sessions were videotaped for research
analysis by the authors.2
The MISC-MUSIC program is based on three components:
1. The didactic approach of Mediated Learning;2. The selection of specific learning skills, defined within the Theory of Structural
Cognitive Modification, to be advanced within music lessons;3. Activities that include listening to music, performance, and creativity.
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Portowitz & Klein MISC-MUSIC 261Portowitz & Klein MISC-MUSIC 261
Mediated Learning
Mediated Learning is a didactic approach aiming to establish teacherchild interaction
that is closely matched and synchronized. While such goals characterize quality teaching
in general, mediated learning environments, defined by specific criteria, are particularly
conducive to the development of specific thinking strategies.
3
The criteria of MediatedLearning, as applied to music education, include:
1. Focusing intentionality and reciprocity: promoting enhanced teacherstudentcommunication, the mediator engages the childs attention, while encouraginghim/her to actively respond, verbally or non-verbally. Application to music: listening to music is a particularly potent means of
developing a childs ability to focus, as it exercises the need to concentrateon auditory input and make sense of it.
2. Expanding going beyond the immediate: stimulating mental flexibility, theteacher directs the educational situation beyond the immediate, expanding the
learning situation to include additional experiences and situations. Application to music: the abstract nature of music leaves room for the teacher
to encourage imaginative and associative thinking, as, for example, whilelistening to such music as the childrens favorites Carnival of the AnimalsbySaint-Sans or Prokofievs Peter and the Wolf.
3. Mediating meaning and excitement: the teachers verbal or non-verbal expressionsof appreciation and excitement with regard to objects, concepts, or issues, mayenhance the childs interest in learning, and arouse his/her curiosity regarding therelevance of the material studied. Application to music: expressing enthusiasm for the musical material arouses
the childrens interest in matters that initially may seem far removed from
familiar experiences. Moreover, defining and naming musical conceptsenriches language and communication skills.
4. Rewarding mediating feelings of competence: the teacher expresses satisfactionwith a childs accomplishments, while identifying the specific components thatcontribute to his/her success. Application to music: encouraging a childs attempts to perform or create
musical patterns offers many opportunities for mediated feelings of competence,specifically with regard to the benefits of hard work and practice.
5. Mediating self-regulation (Klein, 1996): self-regulation is essential for the developmentboth of personal self-control and harmonious interactions with other people. Application to music: lessons devoted to performance, and especially group
ensembles, offer excellent opportunities for mediating self-regulation.
The theory of Structural Cognitive Modifiability as applied to music
The theory of Structural Cognitive Modifiability (Feuerstein, Rand, & Ryders, 1988) focuses
on the cultivation of thinking strategies commonly referred to as cognitive functions. These
skills effect the Input, Elaboration, and Output phases of the mental act: in the Input
phase, the individual gathers information; in the Elaboration phase, the individual
processes the information that has been gathered; and in the Output phase, the individ-
ual communicates his/her response. While listening to, defining, and comparing auditory
stimuli, children engaged in musical activities draw on the following learning skills:
1. The ability to differentiate between and coordinate multiple features of an experi-ence: a child exercises this cognitive function while listening to or performingmusic for example, by taking notice of pitch, rhythm, dynamics, and
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expression (Bamberger, 1991; Brand, 1997; Cohen, 1986; Serafine, 1988). In onesuch exercise, the children in the program were given a board with large andsmall magnets, and were asked to arrange the magnets so that they representedboth the pitch and the rhythm of a short musical piece. The piece consisted oftwo notes, one higher than the other, and two rhythmic values, one long and the
other short. One child, for example, chose to indicate the higher pitch by placingone magnet on top of the other, and the lower pitch by placing just one magnet.The larger magnets were chosen to represent the longer rhythmic values, whilethe smaller magnets indicated the shorter values. Thus, this child conceived a sym-bolic representation that related to multiple components of information.
2. Recognizing patterns or inconsistencies in some attributes and dimensions of anexperience, while change is taking place in others. This cognitive skill enhancesperceptual stability and accuracy. For example, recognizing a musical themedespite melodic, harmonic, or rhythmic variations would require the conservationof patterns. Joseph, for example, was having difficulties in learning to play a newpiece on the electric organ. One of the problems was that he was reading each
note separately rather than following complete musical ideas. In response to thisproblem we grouped notes together, forming a melodic pattern. Recognizing thepattern and noting its recurrence in various contexts helped him learn to play thepiece. Another instance that draws on this cognitive function would be recogni-tion of a given melody even when it is played on a variety of instruments, or incontrasting registers or dynamics. While certain performance elements change, thecore melody remains the same. One of the children responded to this example bysaying that when a child with long hair has a haircut, s/he still remains the samechild.
3. Understanding large-scale structural relations, as opposed to episodic perception,enables a child to construct connections between multiple parts, uniting them into
larger entities while recognizing the individuality of each of the parts. Holistic per-ception involves processes of analysis and synthesis basic to the understanding ofmusical structures (Bamberger, 1991, 2000a; Brand, 1997; Cohen, 1986;Portowitz, 2001; Serafine, 1988). Musical puzzles serve as excellent opportunitiesfor developing this cognitive function. Thus, for example, the squares presented inFigure 1 represent four different patterns heard in Dmitri Kabalevskys Marchfrom The Comedians (Wiggins, 2001).4 After listening to the piece several times,the teacher and child studied the puzzle pieces, noting how the dots and figuresrepresent different melodic and rhythmic events in the piece. This puzzle particu-larly illuminates issues of surface articulation (short, disconnected lines as opposedto more sweeping gestures), duration (larger and smaller circles), and melodic
direction. While listening to the music, the child chose the square that best repre-sented the musical content. A sequential timeline of the piece emerged, whichwas constructed by repeating or alternating between the four puzzle squares.
In another instance, Diane was asked to draw a picture while listening to a songthat described rain falling on flowers and plants. This exercise was intended to revealher understanding of how flowers grow. In her first picture, Diane drew sporadicpictures of raindrops, a flower, and a cloud, indicating an episodic perception(Figure 2a). Discussing the text and acting out the various verses while singing thesong enabled us to emphasize the connections between the clouds, raindrops,flowers, and the growth process. Dianes next attempt resulted in a moreintegrated picture, as the drops fell from the clouds on to the flower (Figure 2b).
Her final picture (Figure 2c) was the most holistic, and included additional detailsmentioned in the song (a tree and a wreath of wheat).
In another instance, while learning about ABA musical forms, the childrencame to recognize that when a musical theme originally heard at the openingof a piece returns to close the piece, it can be regarded as a recall of the
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Portowitz & Klein MISC-MUSIC 263
opening melody, and not as a new entity. This understanding emerged gradually,because it was initially thought that each section in a sequential progressionshould be labeled as new, thus creating an ABC musical form. This principlewas further explained by discussion of the school bell. There is only one bell
in school; however, the children interpret the meaning of its ring according tothe time when it is heard. In the morning, when the children hear the bell,they enter class. In the afternoon, when the children hear the same bell, theyleave class and go home. Thus, the same bell is used to open and close theschool day.
Figure 1 Four puzzle pieces, from which it is possible to create a symbolic representa-tion of Dmitri Kabalevskys March from The Comedians.
Figure 2a Dianes first drawing of the rain song, which seems to indicate an episodicperception.
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4. Precision and accuracy pertain both to gathering and conveying full and preciseinformation. The efforts involved in achieving precision and accuracy necessitateattention and concentration. In music, and especially in performance, thesefunctions are essential. Videos filmed during performance lessons reveal the
Figure 2b Dianes second drawing of the rain song. This attempt is more integrated, asthe rain falls on the flower.
Figure 2c Dianes third picture of the rain song. This is Dianes most integrated pic-ture, reflecting a holistic perception of the process of growth.
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immense effort the children make to play the notes, rhythms, and dynamicsprecisely and accurately. Indeed, the quality of a performance often depends onthe split-second coordinated entrances of the players.
5. Promoting self-regulation: encouraging thinking before doing trains children tostop, think things through and plan before acting. Replacing random responses with
clear plans of action fosters self-discipline, and builds childrens confidence in theirability to complete tasks. Self-regulation is one of the most central skills developedwhile studying music. Learning to play an instrument alone or in a group fostersself-discipline and develops strategies that assist in promoting self-regulation (Kirk,Gallagher, & Anastasiow, 1993; McPherson & Zimmerman, 2002; Oreck, Baum, &McCartney, 1999). Numerous musical activities in which children take turns exerciseself-regulation and self-control: following graphic representations of musical pieces,jointly creating their own pieces, or practicing contrasting levels of musical sounds.
6. The ability to engage in multiple representations offers children who are not fluentin verbal communication an opportunity to convey their ideas using an alternativemodality, such as singing, playing, improvisation, drawing, graphic notation, or
moving to music (Brand, 1997, 2000; Cohen, 1980, 1997; Mualem-Paleov, 2000).Such alternative modes of expression also enhance memory (Balch, Bowman, &Mohler, 1992; Wallace, 1994). Multiple representations can be used to helpteachers assess the childrens musical understanding, especially when their speechis limited (Bamberger, 1991; Cohen, 1997; Gruhn & Rauscher, 2002). Yonahs picturesof Saint-Sans Donkey and Turtle, for example, clearly reflect her grasp of thedifferent rhythms and melodic contours used in describing the motions of the twoanimals (Figure 3).
At times, however, children may use symbols that are not based on conventional adult
musical understanding, obscuring their true intent. In such cases, the drawings may seem
disassociated from the musical content, leading the teacher to suspect that the child didnot understand the musical content. This is not necessarily the case. Josephs drawing of
the Russian Dance from Tchaikovskys Nutcracker Suite, for example, included pictures
totally unrelated to the program of the piece (a house, flowers, grass). Having observed
Figure 3 Yonahs picture represents the Turtle and the Donkey from Saint-SansCarnival of the Animals.
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the drawing process, however, it became clear that his picture indicated a keen
understanding of musical articulation, as he synchronized the completion of each
component in his picture with points of musical closure. Moreover, he chose short, straight
lines to represent staccato musical figures, and rounded lines to indicate legato passages
(Figure 4). In such cases, it is essential that the child be asked to explain his/her work.
Multiple representations also nurture associations that assist children in the organizationof abstract sounds. Movements are particularly helpful. Walking on tiptoe, for example, may
create associations of soft music, while wide, open gestures and foot stepping may become
equated with loud, emphatic musical gestures. Finally, multiple representations may offer a
glimpse into the emotional world of a child. Noa, whose father is blind and whose mother
is mentally retarded, drew a picture while listening to the Fish in Saint-Sans Carnival of
the Animals. She drew a very large number of fish in her picture, explaining that she wanted
the fish to have lots of friends, so that they wouldnt feel lonely.
Reflections
Data collected over a two-year period revealed meaningful findings. First and foremost, the
children who participated in the study became music lovers. Singing, listening, drumming,
and moving to the music became an integral part of their lives, as they gradually evolved
from hesitant bystanders to active learners. Most rewarding, parents reported that children
continued to develop their musical interests at home, singing the songs they had learned
with their siblings and listening to the musical selections that had been recorded for their
personal use. It was satisfying to realize that, even when the focus of a program promotes
art as a tool, the end result also includes the benefits of art for arts sake.
Significant progress was observed in the development of the targeted cognitive func-tions. The childrens world of associations expanded as they connected between, for exam-
ple, the sounds of music and the sounds of nature or animals. They engaged in reading
and designing graphic representations as they translated melodic contour, surface
articulations, and other musical elements into graphic symbols. Such graphic representations
Figure 4 Josephs depiction of the Russian Dance in Tchaikovskys Nutcracker Suite.at SWETS WISE ONLINE CONTENT on September 3, 2010ijm.sagepub.comDownloaded from
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Portowitz & Klein MISC-MUSIC 267
were the basis for moving on to an understanding of concepts of sequencing, repetition,
variation, and contrast prerequisites to establishing connections between the flow of
events in time and space. Grappling with rhythmic and melodic notation, tempo consid-
erations, and dynamics, the children learned how to deal with the necessity of consider-
ing several sources of information at the same time, especially when considering the
emotional content of the music (Why is this piece so exciting? What happens when themusic gets softer?). Through improvisation, the children internalized the defining features
of patterns as they transposed short melodic motives on different degrees of a scale, or
performed short rhythmic patterns on a variety of instruments. While learning to look after
the musical instruments and the audio equipment carefully, they came to value and respect
their studies and the equipment that enabled them to learn. Social skills developed
markedly within group activities that included the child, parent, sibling, and teacher,
enabling the children to maintain longer chains of communication. As the music provided
for focused stimulation, the children asked more questions, and shared their feelings, pref-
erences, and ideas, all reflecting a growing curiosity and interest in connecting with the
people and events around them. Performing ensembles demonstrated the contribution ofall the participants to the group effort. Inviting siblings to partake in the lessons proved
to be especially beneficial. Such activities supported two-way communication, including
opportunities for modeling of normative behavior as well as recognizing and respecting
the abilities of a weaker sibling, who successfully sang all the words of a song and exhib-
ited proficiency in fulfilling many of the musical exercises.5
In conclusion, although music always exists as a source of human enjoyment and emo-
tional release, our research supports its additional function as a promoter of cognitive
processes. While still in the early stages of development, the growing corpus of positive
findings could encourage researchers to apply this approach in multiple situations,
thereby expanding the long-term effects of their music programs. Of particular interest,studies of mediated musical environments could provide important insights into the learn-
ing potential of other groups of children with special needs, such as at-risk children and
children growing up in multicultural environments.
Notes
This study has been supported in part by the MACHADO chair for research on cognitive modifiability and
the development of intelligence.
1. For more information about the MISC programs, see http://www.biu.ac.il/Community/barbaker.shtml2. The analysis monitored the quality of the teaching behavior, as well as the development of the chil-
drens learning skills. The childrens progress was monitored in comparison with a baseline, grounded
on initial interviews with the parents, school reports, professional referrals, select tests of the childs
cognitive and social functioning, and language proficiency.
3. Numerous empirical studies testify to the contribution of mediated learning to cognitive and social
development. See, for example, Feuerstein et al., 1988; Kang and Tan, 2003; Klein, 1988, 1991,
1996, 2003; Klein, Weider, and Greenspan, 1987; Sobelman-Rosenthal, 1999; Tzuriel, 1999; Tzuriel
and Ernst, 1990; Zambrana-Ortiz and Lidz, 1995.
4. The Norwegian music educator Magne Espeland conceived of the idea of music puzzles. This exam-
ple appears in Jackie Wiggins (2001) Teaching for Musical Understanding, p. 172.
5. Readers interested in learning more about the MISC program can contact the author at
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Adena Portowitz is a musicologist with special interests in Music and Cognition andClassical Music (especially the music of Mozart). She is Head of Research at the Music
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270 INTERNATIONAL JOURNAL OF MUSIC EDUCATION 25(3)
Division of the Yehuda Amir Institute for Social Integration in the Schools, Bar-IlanUniversity, and directs the Musical-Minds Jaffa program, dedicated to promotingcognitive, social, and emotional skills among at-risk children through the study ofmusic. She is Israels national coordinator for the activities of the International YehudiMenuhin Foundation, Brussels, and the Israeli representative to the international
research team headed by Professor Gary McPherson, studying Factors affecting primaryand secondary school childrens motivation to study the visual arts and music. Shelectures at the Interdisciplinary BA Department of the Humanities, Bar-Ilan University,is the author of many articles in the fields mentioned, and currently serves as editorof Min-Ad: Israel Studies in Musicology Online.Address: Music Division of the Yehuda Amir Institute for the Advancement of Teaching,Learning, and Social Integration in the Schools, Department of Education, Bar-IlanUniversity, Ramat-Gan, Israel. [email: [email protected]]
Pnina S. Klein is Head of the Baker Center for Research and Treatment of Children withSpecial Needs, and Professor of Education and Early Childhood Development atBar-Ilan University, Israel. She has developed the MISC approach for early interventionon which this research is based. She has been Head of the Learning Disabilities Clinicat Adelphi University. She has published her research in many international scientific jour-nals and books. She has served as a consultant for international organizations such asthe World Health Organization, UNICEF, and Save the Children in Africa, Asia, and theUnited States. She has received many distinguished national and international awards,including the Most Distinguished Woman in Israeli Education and the Israel-CanadaFoundation Award, and she is an I. B. Harris grantee (USA).Address: Baker Center for Research and Treatment of Children with Special Needs, Bar-Ilan University, Ramat-Gan, Israel. [email: [email protected]]
Abstracts
Un programme de musique pour augmenter des comptences dapprentis-sage parmi des enfants en difficults scolaires
Les rsultats de recherches confirment les liens positifs entre lducation musicale, la
russite scolaire et ladaptation sociale, particulirement parmi les enfants -risque et aux
besoins spciaux. Cependant, peu dtudes expliquent le droulement du processus.
Cette tude prsente une approche didactique qui propose des manires concrtesdaugmenter des comptences dapprentissage gnrales tout en enseignant la musique.
Conduit avec des enfants en bas ge en difficults scolaires graves, gs de 4 10 ans,
le MISC-MUSIC (More Intelligent and Socially Compliant Children [Klein, 1996]) lie en-
semble les trois lments suivants: (1) le contenu des leons de musique; (2) la cration
de structures ducatives, qui consolident la qualit des interactions actives entre lenseignant
et lenfant (environnements dapprentissage mdiatiss); et (3) le choix de comptences
dapprentissage adquates et gnrales (fonctions cognitives) stimuler pendant la leon
de musique. Larticle explique les prmices thoriques de MISC-MUSIC, cite des exemples
de la faon dont cette approche a t appliqu, et rend compte de lefficacit du pro-
gramme.
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Ein Musikprogramm zur Steigerung kognitiver Verarbeitung bei Kindern mitLernschwierigkeiten
Forschungsresultate besttigen positive Verbindungen zwischen Musikerziehung, schulis-
cher Leistung und sozialer Anpassung, speziell bei gefhrdeten Kindern und solchen mit
speziellen Bedrfnissen. Jedoch gibt es nur wenige Studien die erklren, wie dieser Prozessverluft. Diese Studie beschreibt einen didaktischen Zugang, der praktische Wege vorschlgt,
wie im Laufe des Musikunterrichtes allgemeine Lernfertigkeiten verbessert werden knnen.
Durchgefhrt mit kleinen Kindern mit ernsthaften Lernschwierigkeiten im Alter von 410
Jahren, schafft das MISC-MUSIC (More Intelligent and Socially Compliant Children; Klein,
1996) Programm Verbindungen zwischen den drei folgenden Komponenten: (1) dem Inhalt
der Musiklektionen; (2) dem Gestalten eines erzieherischen Aufbaus mit frdernden
Qualitten, einer aktiven LehrerSchler Interaktion (vermittelndes Lernumfeld); und (3)
der Wahl relevanter, allgemeiner Lernfertigkeiten (kognitive Funktionen) um whrend der
Musiklektionen gefrdert zu werden. Der Artikel beschreibt die theoretischen
Voraussetzungen, von MISC-Music zitiert Beispiele wie dieser Zugang eingefhrt wurde;und reflektiert ber die Wirksamkeit des Programmes.
Un programa de musica para mejorar el progresamiento cognitivo en losninos con dificultdades de aprendizaje
La investigacin confirma vnculos positivos entre la educacin musical, los logros esco-
lares y la adaptabilidad social, especialmente entre nios en situacin de riesgo y con
necesidades educativas especiales. Sin embargo, pocos estudios explican cmo sucede ese
proceso. Este trabajo presenta un enfoque didctico en el que se sugieren formas prc-
ticas para desarrollar las destrezas de aprendizaje general en la enseanza de la msica.
El programa MISC-MUSIC (acrnimo ingls para Nios ms Inteligentes y SocialmenteObedientes [Klein, 1996]), llevado a cabo con nios de 4 a 10 aos con graves dificul-
tades de aprendizaje, conecta tres componentes: (1) el contenido de las clases de msica;
(2) la creacin de marcos educativos que nutren interacciones profesor-nio activas y de
calidad (contextos de aprendizaje mediado); y (3) la eleccin de destrezas de aprendizaje
general relevantes (funciones cognitivas) que se fomentarn durante la clase de msica.
Este artculo explica las premisas tericas de MISC-MUSIC, cita ejemplos de cmo se
implement el enfoque y reflexiona sobre la efectividad del programa.
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